CD13 is a large, multifunctional cell surface peptidase that is constitutively expressed on all lineages of myeloid cells (among others) and upregulated on endothelial cells at sites of angiogenesis and inflammation. Collectively, our recent studies demonstrate that CD13 regulates endocytosis of receptors of disparate classes in different cell types to control downstream signal transduction pathways, implicating a role for CD13 in fundamental cellular processes. More recently, we showed that in dendritic cells (DCs) CD13 regulates endocytosis of the toll-like receptor TLR4 which is a critical sentinel of the innate immune response to pathogens via PAMPs (pathogen-associated molecular patterns) and DAMPs (danger associated molecular patterns). Binding of DAMPs to macrophage and DC TLR4 in the absence of CD13 leads to an unbalanced cytokine response and aberrantly high levels of type I interferons (IFNs) due to skewed endocytic-signaling pathways. Although beneficial in anti-viral responses, strong IFN responses clearly exacerbate the patho- genesis of TLR4-binding PAMPs and DAMPs. Furthermore, we have additional evidence implicating CD13 in receptor recycling to the cell surface. To model this in vivo we subjected wild type and CD13null animals to permanent femoral artery dissection, which releases endogenous ligands that TLR4 recognizes as DAMPs. Functionally, CD13null mice have strikingly impaired ambulation and perfusion recovery and more necrosis consistent with impaired healing. Furthermore, cytokine profiles in the ischemic muscle showed markedly increased levels of IFN- and IL-10 consistent with our in vitro data and with studies where TLR4 engagement by PAMPs or DAMPs leads to exaggerated pathology suggesting that CD13 regulates the balance between pro-inflammatory and IFN-generating signal transduction in myeloid cells. Furthermore, marrow transplant studies demonstrating that CD13null donor hematopoietic cells are unable to rescue perfusion and function in wild type ischemic muscles validate this notion and highlights the importance of fully understanding the mechanistic basis of this novel regulator. Finally, while it is clear that the individual subsets of myeloid cells of the innate immune response orchestrate subsequent steps in the healing process, their relative contributions and specific roles are largely unknown. Pertinent to this proposal, macrophage and DC TLR4 signaling occurs via both cell surface and endocytic mechanisms supporting discrete regulatory processes and cell-specific roles for these largely uncharacterized pathways in distinct cell types. Therefore, through its regulation of endocytosis, we propose that myeloid CD13 is a functional regulator of innate immunity and dissection of the relative contributions of CD13 expressed on pan-myeloid (lysM-cre) and DCs (CD11c-cre) to these regulatory processes will clearly increase our understanding of myeloid cells in response to ischemia, information essential to the design of strategies to regulate healing by manipulating this novel target.